Obamacare is incrementally expanding health insurance coverage, but the industry’s fine print is proliferating as well. Many health plans are marketing “wellness” programs as a pathway to a “healthy lifestyle” that rewards good behavior with discounted rates. But the seductive marketing should come with a disclaimer: Wellness programs aren’t for everyone.
The Affordable Care Act encourages providing wellness programs as a form of preventive care, avoiding costly medical burdens down the line. Insurers have expanded these programs to about “94 percent of employers with over 200 workers, and 63 percent of smaller ones,” according to federal research. Insurers could offer 30 percent lower premiums, for example, in exchange for employees’ giving up smoking, or cash for enrolling in an employer-approved gym membership. The Obama administration just issued new rules on using wellness programs in compliance with civil-rights protections, but rights advocates say some groups risk being indirectly penalized or excluded due to subsurface medical profiling.
Exclusionary “wellness” protocols could chafe against two civil-rights protections, the Americans with Disabilities Act and Genetic Information Nondiscrimination Act. Though Obamacare was supposed to prevent the exclusion of “high risk” consumers from coverage due to preexisting health issues, wellness programs seem structured to potentially do exactly that.
In its rulemaking notice the Equal Employment Opportunity Commission (EEOC) stated it did not see a need to mandate more stringent consumer protections, like ensuring workers can challenge the accuracy of screening results.
The National Partnership for Women and Families (NPWF) testified at a Senate hearing last year that lax federal regulations could indirectly enable bias by another name, as insurers “shift costs and withhold rewards from employees with health problems.” The program requirements could expose vulnerable or marginal groups to discrimination, potentially leaving “women, workers of color, older workers and those with disabilities” on a lower tier of care.
“Incentivizing” wellness sounds innocuous enough, but, as NPWF’s senior policy counsel Sara Fleisch Fink explains, “the flipside of a company being able to provide an ‘incentive’ [such as] 30 percent off of the cost of health insurance for participation in a wellness program, is that employees who do not participate will pay 30 percent more for their health insurance.”